Patients with MwoA also had significantly lower scores on 4 out of 6 cognitive sub-scores in executive function, attention, and visuospatial and memory domains, with a significant relationship between executive domain scores and attack-related migraine disability, they found.

"Taken together, our findings suggest that MwoA is associated with cognitive dysfunction and in particular, that altered executive functioning can be related to high migraine-related disability," they wrote, adding that these results "underscore the importance of a careful evaluation of cognitive function."

"We believe that early identification of cognitive deficits in MwoA patients is relevant for future care planning," they wrote. "The MoCA seems suitable to screen such cognitive defects in clinical practice in MwoA patients."

For the study, the researchers enrolled 72 drug-naïve patients with MwoA who were referred to the outpatient Headache Clinic at the University of Naples from September 2014 to June 2015. There were 63 women and nine men.

Cognitive function was compared with that of 72 healthy controls using MoCA. Patients were matched for age and education and there was no significant difference in gender distribution between the two groups.

Any study patient with a history of somatic or psychiatric disorders such as major depression or psychosis was excluded, and all MwoA patients had to be migraine- and rescue medication-free for at least three days before and after the neuropsychological assessment.

The researchers found that MwoA patients performed significantly worse than healthy controls on the total MoCA score (22.3 versus 25.4) as well as on its attention (4.9 versus 5.6), memory (1.8 versus 3.1), visuospatial (3.2 versus 3.6), and executive subscales (2.6 versus 3.1).

The study did not reveal any significant difference between the groups on language and orientation and none of the participants had a total MoCA score below normative values for Italy.

Nor were there any differences between severity of depression, apathy, and state and trait anxiety in MwoA patients compared with healthy controls. This finding runs counter to previous studies reporting depression, anxiety disorders, and migraine as co-morbid diseases, the study authors acknowledged.

They added, however, that this observation does support findings from a 2016 epidemiologic study suggesting that psychiatric comorbidity occurs less frequently in patients with MwoA than in patients who experience migraine with aura or medication-induced headache.

Reduced cognitive performance didn't appear to be related to pain intensity, disease duration, or the frequency of attacks, the researchers said. This finding is in keeping with previous studies and suggests that "subtle alterations in information processing mechanisms might be present also in the early stages of migraine."

William Young, MD, of Thomas Jefferson University in Philadelphia, who was not involved in the study, said it "isn't perfect and it raises a lot of questions and doesn't answer many of them. This is a cross-sectional study across one point in time and you can't really say much about what's causing what."

Young told MedPage Today that little is known about the cognitive consequences of pain, particularly episodic pain.

For the primary care physician with a patient who suffers from migraine and has complaints about cognition, it's important to rule out other problems first, Young advised: "Check the thyroid, check blood chemistries, and make sure he or she doesn't have a vitamin deficiency."

When other possible sources of a patient's complaints about cognition are ruled out, look into migraine: "These complaints may be real and may go away if migraine is treated," he said.

A study that looks at whether cognition is improved when migraine is treated well "would be a very impressive study," Young added. "This may be the next place to take a study of this kind."

The study authors disclosed no funding sources or competing interests.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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